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Stress in childhood and the risk of type 1 diabetes
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: It is still unknown why children develop type 1 diabetes (T1D), although both genetic predisposition and environmental factors seems to be involved. Stress has been suggested as one environmental factor contributing to the development of T1D since the stress hormones may increase the need for insulin or increase insulin resistance. The family is important for the child’s emotional security, development, and regulation of emotions, hence stress among the parent’s may influence the child’s experiences of stress and coping with stressors.

Aim: The aim of the current thesis was to evaluate self--‐assessment measurements of psychological stress in the family and to investigate if psychological stress in the family is involved in the development of childhood T1D.

Methods: The All Babies in Southeast Sweden (ABIS) study is a prospective cohort study following children born in southeast Sweden between 1997 and 1999. All parents of children born in the region, approximately 21600 were asked to participate. In total, questionnaire data has been obtained from n=16142 (response rate approximately 75%) in some of the six data--‐collections and between 15845 (73%) and 4022 (19%) at each data collection. Psychological stress in the family was measured by questionnaires assessing: Serious life events experienced by the child and the parent, parenting stress, parental dissatisfaction, parental worries, the parent’s adult attachment, and the parents’ social support. Identification of cases with T1D was done through the national register SweDiabKids. At Dec the 31st 2012 had in total 104 (0,64%) children been diagnosed with T1D. Diabetes--‐cases included in the study samples was n=42 and n=58.

Results: Parenting stress, parental worries, and size of social support were judged as reliable measurements assessing different aspects of psychological stress in the family, as well as they were all associated to children’s mental health in early adolescence. A serious life event experienced in childhood (measured by checklist at age 5--‐6, 8 and 10--‐ 14 years) was associated with an increase in risk for manifest T1D up to 13--‐15 years of age. None of the variables measuring psychological stress among parents were found to associate with risk of T1D.

Conclusions: In addition to a checklist assessing serious life events experienced by the child is self--‐assessment measurements of parenting stress, parental worries and the parent’s social support be useful in large--‐scale studies as proxies for psychological stress of the child. The current study is the first unbiased prospective study that can confirm an association between the experience of a serious life event and increased risk of T1D. The result was independent of the child’s BMI and the parents’ educational level. Our results gives us strong reason to believe that psychological stress caused by serious life events can play a part in the immunological process leading to the onset of T1D.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 94 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1475
National Category
Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-121066DOI: 10.3384/diss.diva-121066ISBN: 978-91-7685-973-5 (print)OAI: oai:DiVA.org:liu-121066DiVA: diva2:851358
Public defence
2015-09-25, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2016-04-01Bibliographically approved
List of papers
1. Adult attachment and parenting stress among parents of toddlers
Open this publication in new window or tab >>Adult attachment and parenting stress among parents of toddlers
2012 (English)In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 30, no 3, 289-302 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to revise the dimensionality of the Relationship Scales Questionnaire (RSQ) assessing adult attachment and relate it to parenting stress within a large sample of parents of toddlers. Methods: As part of a longitudinal population-based study, 8122 parents (97% mothers) completed the 18-item version of RSQ and the Swedish Parenthood Stress Questionnaire (SPSQ) when their child was 2-3 years of age. Results: Exploratory factor analyses gave three uncorrelated RSQ factors named (1) Importance of Independence, (2) Relationship-related Anxiety, and (3) Discomfort with Closeness, with Cronbachs alpha andgt;= 0.65. In a linear regression Parenting Stress was most closely related to Relationship-related Anxiety (b = 0.20, t = 39.0), weaker associations were found with the attachment dimensions capturing avoidance: Importance of Independence (b = 0.07, t = 13.40) and Discomfort with Closeness (b = 0.07, t = 12.04). The SPSQ subscales Incompetence (R-2 = 17%) and Social Isolation (R-2 = 22%) showed stronger association with adult attachment than the remaining three. Conclusion: The agreement with previous findings in other study populations indicates that substantial and meaningful dimensions of attachment have been captured. Attachment anxiety and discomfort with closeness seem to have an important relationship with the perception of parenting stress, especially concerning feelings of incompetence and social isolation.

Place, publisher, year, edition, pages
Taylor and Francis (Routledge): STM, Behavioural Science and Public Health Titles / Taylor and Francis (Routledge), 2012
Keyword
adult attachment, attachment styles, parenting stress, parenting, family relations
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84912 (URN)10.1080/02646838.2012.717264 (DOI)000308760100006 ()
Available from: 2012-10-26 Created: 2012-10-26 Last updated: 2017-12-07
2. Family psychological stress early in life and development of type 1 diabetes: The ABIS prospective study
Open this publication in new window or tab >>Family psychological stress early in life and development of type 1 diabetes: The ABIS prospective study
2013 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 100, no 2, 257-264 p.Article in journal (Refereed) Published
Abstract [en]

Aims: This study investigated whether psychological stress in the family during the childs first year of life are associated with the risk of childhood type 1 diabetes (T1D). According to the beta-cell stress hypothesis all factors that increase the need for, or the resistance to, insulin may be regarded as risk factors for T1D. less thanbrgreater than less thanbrgreater thanMethods: Among 8921 children from the general population with questionnaire data from one parent at childs birth and at 1 year of age, 42 cases of T1D were identified up to 11-13 years of age. Additionally 15 cases with multiple diabetes-related autoantibodies were detected in a sub-sample of 2649 children. less thanbrgreater than less thanbrgreater thanResults: Cox regression analyses showed no significant associations between serious life events (hazard ratio 0.7 for yes vs. no [95% CI 0.2-1.9], p = 0.47), parenting stress (0.9 per scale score [0.5-1.7], p = 0.79), or parental dissatisfaction (0.6 per scale score [0.3-1.2], p = 0.13) during the first year of life and later diagnosis of T1D, after controlling for socioeconomic, demographic, and diabetes-related factors. Inclusion of children with multiple autoantibodies did not alter the results. less thanbrgreater than less thanbrgreater thanConclusions: No association between psychological stress early in life and development of T1D could be confirmed.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Diabetes mellitus, Type 1, Stress, Psychological, Life change events, Educational status, Prospective studies
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-95975 (URN)10.1016/j.diabres.2013.03.016 (DOI)000320590900024 ()
Note

Funding Agencies|Swedish Research Council|K2005-72X-11242-11AK2008-69X-20826-01-4|Swedish Child Diabetes Foundation (Barndiabetesfonden)||JDRF Wallenberg Foundation|K 98-99D-12813-01A|Medical Research Council of Southeast Sweden (FORSS)||Swedish Council for Working Life and Social Research|FAS2004-1775|

Available from: 2013-08-19 Created: 2013-08-12 Last updated: 2017-12-06Bibliographically approved
3. Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study
Open this publication in new window or tab >>Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study
Show others...
2015 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no 6, 1188-1197 p.Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis The aim of this study was to prospectively investigate whether psychological stress during childhood may be a risk factor for manifest type 1 diabetes. Methods The All Babies In Southeast Sweden (ABIS) study invited all families with babies born between 1 October 1997 and 30 September 1999 in southeast Sweden to participate. Our study subsample includes 10,495 participants in at least one of the data collections at 2-3, 5-6, 8 and 10-13 years of age not yet diagnosed with type 1 diabetes at inclusion; 58 children were subsequently diagnosed. Age at diagnosis was obtained from the national register SweDiabKids in 2012. Family psychological stress was measured via questionnaires given to the parents assessing serious life events, parenting stress, parental worries and the parents social support. Results Childhood experience of a serious life event was associated with a higher risk of future diagnosis of type 1 diabetes (HR 3.0 [95% CI 1.6, 5.6], p = 0.001) after adjusting for heredity of type 1 diabetes and age at entry into the study. The result was still valid when controlling for heredity of type 2 diabetes, size for gestational age, the parents education level and whether the mother worked at least 50% of full time before the childs birth (HR 2.8 [95% CI 1.5, 5.4], p = 0.002), and also when childhood BMI was added to the model (HR 5.0 [95% CI 2.3, 10.7], p less than 0.001). Conclusions/interpretation This first prospective study concluded that experience of a serious life event in childhood may be a risk factor for manifest type 1 diabetes.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keyword
Longitudinal studies; Prospective studies; Psychological stress; Risk factors; Stressful events; Type 1 diabetes mellitus
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-118842 (URN)10.1007/s00125-015-3555-2 (DOI)000353893000008 ()25870022 (PubMedID)
Note

Funding Agencies|Swedish Research Council [K2005-72X-11242-11A, K2008-69X-20826-01-4]; Swedish Child Diabetes Foundation (Barndiabetesfonden); JDRF Wallenberg Foundation [K 98-99D-12813-01A]; Medical Research Council of Southeast Sweden (FORSS); Swedish Council for Working Life and Social Research [FAS2004-1775]

Available from: 2015-06-08 Created: 2015-06-04 Last updated: 2017-11-02
4. Serious life events across childhood and mental health problems in early adolescence: The moderating role of family climate. Results from the ABIS population-based longitudinal study
Open this publication in new window or tab >>Serious life events across childhood and mental health problems in early adolescence: The moderating role of family climate. Results from the ABIS population-based longitudinal study
Show others...
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

This study aims to investigate the association between experiences of serious life events assessed by checklists longitudinally across childhood (at age 5-6, age 8, and age 12-14 years) and level of mental health problems in early adolescence (at age 12-14), and the mediating role of family climate factors across childhood. Questionnaire data from the All Babies In Southeast Sweden (ABIS) population based cohort-study were used (n=1132). The association were best modelled with a sequential cumulative approach; that means that the number of time-periods at least one serious life event was experienced were linearly related to the level of mental health problems (SDQ-score) after controlling for age, sex/gender, parental educational level, immigrant status and fuzzy/difficult temperament at age 2-3 (b=0.58 [95% CI 0.28, 0.87], p<0.001). Parenting stress and the parents size and satisfaction of social support were found as moderating factors, where the association between serious life events and mental health problems only were found in the subgroups of families where the parent perceive chronically high levels of parenting stress (high at 3-4 times of 4 possible; n=163, b=1.28 [0.55, 2.01], p=0.001), have a small social network (n=108, p=1.75 [0.86, 2.64], p<0.001), and are dissatisfied with their social support (n=95, p=1.22 [0.36, 2.09], p=0.006). An absence of parenting stress across childhood and adequate social support for the parents are suggested as resilient factors. To avoid negative consequences for child mental health after experiences of stressful life events, parents should get adequate support in child health services.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes Pediatrics
Identifiers
urn:nbn:se:liu:diva-121065 (URN)
Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2017-11-02Bibliographically approved

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